La présence synchrone de métastases hépatiques (MH) et carcinose péritonéale (CP)d'origine colorectale (CRC) est associée à une survie globale médiocre et est traditionnellement considérée comme une contre-indication à l’approche chirurgicale curative. Cependant, suite aux résultats encourageants après traitement chirurgicale, quelques séries ont rapporté une survie prolongée atteignant 3 ans chez des patients sélectionnés, ce qui suggère qu’un traitement chirurgicale curative est possible. À ce jour, en cas de chirurgie majeure hépatique et péritonéale associée, aucune stratégie thérapeutique n'a été établie, Nous avons postulé que la régénération hépatique après une résection hépatique pourrait favoriser la croissance de la CP. Nous avons construit un modèle animal immunnocompetent de CP limitée. L'objectif de l’étude était d'analyser les effets de l’hépatectomie majeure et de la régénération hépatique dans notre modèle murin de PC et le processus d'angiogenèse associé. En outre, nous avons analysée une cohorte prospective multicentrique de patients ayant eu une résection hépatique et une chirurgie cytoréductive avec HIPEC synchrone. L'objectif de cette étude était d'évaluer les outcomes et identifier les facteurs pronostiques afin d'optimiser la sélection des candidats au traitement chirurgical et de déterminer la stratégie chirurgicale optimale. / The synchronous presence of liver metastases (LM) and peritoneal carcinomatosis (PC)from colorectal cancer (CRC) is associated with poor outcome and is traditionally considered acontraindication to any surgical approach. However, few series reported a prolonged survival aftersurgical management, reaching 3 years in selected patients thus suggesting that a curative surgicalmanagement may be possible. To date, no standard management pathway has been established,especially if a major liver and peritoneal surgery has to be performed. We postulated that liverregeneration after liver resection could promote PC growth. We constructed an immunocompetentanimal model of limited PC. The objective of our study was to analyze the effects of major LR andliver regeneration after hepatectomy on peritoneal carcinomatosis growth and the associatedangiogenesis process. Furthermore, we have analyzed a prospective international cohort of patientsundergoing synchronous liver resection and cytoreductive surgery with HIPEC. The aim of this studywas to describe the outcomes, to identify variables potentially related to poor outcome, in order toestablish future guideline for the management of these patients, to optimize the selection of candidatesfor surgical treatment and determine the best surgical strategy.

Lymphatic metastasis in breast cancer (BC) is one of the most important prognostic factors for patient survival. The escaped tumor cells reach distant vital organs and their unopposed expansion in these organs may cause mortality to patient. Tumor cells are transported to lymph node (LN) exclusively by tumor lymphatic vessels (LV). Increased tumor lymphangiogenesis, i.e., the formation of new LV is currently thought to be promoted by soluble factors such as VEGF-C and –D that activate VEGFR-3 expressed in lymphatic endothelial cells (LEC). These factors are secreted by malignant, tumor-infiltrating immune and stromal cells and create a favorable environment for formation of new vessels. However, emerging evidence suggests that tumor lymphangiogenesis is also promoted by Myeloid-derived Lymphatic Endothelial Cell Progenitors (M-LECP). We recently showed that M-LECP are abundant in mouse and human breast tumors and that their density strongly correlates with both lymphatic formation and nodal metastasis. Characterization of M-LECP showed that nearly all these cells express typical markers of the M2-type of macrophages such as CD163, CD204, and CD209. These cells are consider to be strongly immunosuppressive as exemplified by their inhibition of mobilization, activation, and survival of the key defenders against cancer cells, cytotoxic CD8+ T lymphocytes. Here, we compare the in vitro differentiation of M-LECP derived from bone marrow (BM) myeloid precursors primed with CSF-1 followed by secondary stimulants such as LPS, an immunomodulatory ligand for TLR4, and IL-4, IL-13, and IL-10 downstream targets of this receptor that are known to promote M2-macrophage development. Expression of these stimulants was analyzed by qPCR, flow cytometry, and ELISA during M-LECP differentiation. Our study describes the expression and functionality of these Th2 cytokines and their receptors during M-LECP differentiation. We found that each of the Th2 pathways singularly promotes M-LECP differentiation but there is an absent additive effect. We also found that IL-10 but no other Th2 cytokines is upregulated along with its receptor and contributes to the expression of the lymphatic properties similarly to LPS. To our knowledge, the role of IL-10 in development of lymphatic phenotype through differentiation of M-LECP has not been reported previously. Lastly, we show recruitment of M-LECP in a mouse BC model and the co-expression of the Th2 cytokine receptors in these cells. These studies have a potential to identify new regulators of M-LECP production in the bone marrow that could serve as biomarkers and targets for inhibiting tumor lymphatic formation, and by extension, lymph node metastasis.